DISMEMBERED LAPAROSCOPIC PYELOPLASTY WITH ANTEGRADE PLACEMENT OF URETERAL STENT: SIMPLIFICATION OF THE TECHNIQUE
|
|
- Mildred Allen
- 6 years ago
- Views:
Transcription
1 Surgical Technique International Braz J Urol Official Journal of the Brazilian Society of Urology Vol. 28 (5): , September - October, 2002 DISMEMBERED LAPAROSCOPIC PYELOPLASTY WITH ANTEGRADE PLACEMENT OF URETERAL STENT: SIMPLIFICATION OF THE TECHNIQUE HENRIQUE RODRIGUES, PAULO RODRIGUES, MARCOS RUELA, ANTÔNIO BERNABÉ, GILBERTO BUOGO Instituto Albarran de Urologia, Rio de Janeiro, RJ, Brazil ABSTRACT Laparoscopic pyeloplasty is an effective treatment option for ureteropelvic junction obstruction, with success rates superior to other minimally invasive approaches. We describe our technique of laparoscopic pyeloplasty with antegrade placement of ureteral stent with a laparoscopicguided abdominal puncture. This technique decreases the use of fluoroscopy and also facilitates renal pelvis dissection and ureteropelvic anastomosis. Key words: laparoscopy; kidney; ureter; ureteral obstruction Int Braz J Urol. 2002; 28: INTRODUCTION In recent years many treatment modalities have been developed to manage ureteropelvic junction obstruction (UPJO), such as antegrade or retrograde endopyelotomy, the Acucise cutting balloon, and ureteral dilation. Despite they are all minimally invasive alternatives, the success rates of these procedures is low (70-80% in well-selected patients) when compared to the traditional open pyeloplasty, with success rates around 90% (1,2). In 1993 Schuessler et al. (3) performed the first laparoscopic pyeloplasty and since then many papers have shown that this technique is a safe and effective treatment for UPJO (4,5). One of the most difficult steps in laparoscopic pyeloplasty is the ureteropelvic anastomosis when the classic dismembered technique (Anderson-Hynes) is performed. Beyond the complexity imposed by the intracorporeal suturing, the presence of an ureteral stent (previously placed by cystoscopy) in front of the anastomotic site makes the suture even more difficult and time-consuming. We developed an alternative technique for placing the ureteral stent in an antegrade fashion, through a laparoscopic guided percutaneous puncture. This technique decreases the use of radiation, and facilitates the ureteropelvic junction (UPJ) dissection and the ureteropelvic anastomosis. SURGICAL TECHNIQUE Preoperative Evaluation All patients undergo an intravenous pyelogram with furosemide and a renal scan preoperatively. If the surgeon intends to perform a retrograde pyelogram prior to the surgery, this can be done just before the laparoscopic access, or preoperatively in a separate procedure, as no preoperative stent is placed. Patient Preparation All patients are admitted to the Hospital the day before surgery, and begin oral bowel preparation with sodium phosphate, and intravenous antibiotic 439
2 Figure 1 - Patient position for laparoscopic pyeloplasty. The patient in a slight flank position, with the side to be operated rotated up to 45 o. prophylaxis with cefazolin 1 hour before the surgical procedure. Bladder Catheterization In the operating room, bladder catheterization is performed with an 18F 3-way Foley catheter. The irrigation path of the Foley catheter is connected to a 500cc bottle of 0.9% saline solution mixed with methylene blue. Patient Positioning The patient is positioned in a slight flank position with the side to be operated rotated up to 45 o with a role (Figure-1). The pressure points are protected with pads, and the patient is fixed to the table with cloth tape, allowing the table to be rotated during the surgery. The surgeon and the camera are placed in the contralateral side with the TV monitor in front of them. Figure 2 - Trocar placement for left laparoscopic pyeloplasty. For right pyeloplasty all trocars are placed in the midline. 440
3 Port Placement We routinely use transperitoneal approach to access the UPJ. After the creation of pneumoperitoneum with a Veress needle (with abdominal pressure of 12mmHg), we place the three 10-12mm ports in a linear configuration at the midline for right pyeloplasty. For the left side, we place the right-hand trocar just lateral to the lateral border of the rectus muscle (Figure-2). The middle trocar is positioned in the umbilicus for both right and left sides. A fourth 5mm trocar may be placed, if necessary, in the subcostal region at the level of the anterior axillary line, and may be used to retract adjacent organs. Colon Mobilization and Ureter and Renal Pelvis Identification The parietocolic and renocolic ligaments are divided, allowing the colon be moved medially, thus providing exposure of the retroperitoneum (Figure- 3). At this point, the dilated renal pelvis can be seen posteriorly to the colon. The administration of 20mg of furosemide intravenously helps to dilate the renal pelvis (as it is not previously catheterized), and facilitates its dissection. The ureter is identified and isolated just below the inferior pole of the kidney, and carefully dissected cranially up to UPJ, in order not to compromise its blood supply. The anterior and posterior aspects of the renal pelvis and UPJ are dissected with a gauze, creating as much space as possible to perform a tension-free anastomosis. Figure 3 - The parietocolic ligament is divided allowing exposure of the retroperitoneal space and access to the UPJ. Figure 4 - The renal pelvis and ureter are identified after the division of renocolic ligaments, and medial retraction of the colon. After dissection of the renal pelvis and UPJ, a stitch is passed with a straight needle in the most dependent portion of the inferior border of the renal pelvis. This stitch exits through the abdominal wall, allowing the renal pelvis to be pulled up from outside. Renal Pelvis Repair After wide dissection of the renal pelvis and UPJ, we pass a stitch through the anterior wall of the renal pelvis in order to make its retraction possible from outside the peritoneal cavity, avoiding the need of another trocar. For this purpose, a 3-0 nylon with a straight needle is introduced through the abdominal wall, about 1cm lateral to the most cranial port. As it is seen on the monitor, the needle is taken by the laparoscopic needleholder, passed through the inferior border of the renal pelvis on its most dependent portion, and then through the abdominal wall again, from inside to outside, as close as possible to its entrance site (Figure-4). The two ends of the suture are grasped with a hemostat, allowing the assistant to retract the anterior wall of the renal pelvis by simply pulling up the hemostat and thus opening the UPJ. UPJ Resection and Ureteropelvic Anastomosis The obstructed UPJ is resected together with the redundant renal pelvis when necessary (Figure- 5). When the UPJ is resected, care should be taken not to cut the nylon stitch previously placed. The ureter is then spatulated on its lateral aspect (facing the medial aspect of the kidney) (Figure-6). We routinely perform interrupted suture with 5-0 polygalactin. The first stitch is passed in the medial 441
4 Figure 5 - The obstructed UPJ is resected leaving a margin of normal tissue to perform the anastomosis. Note that the renal pelvis is opened as close as possible to the nylon stitch. Figure 6 - The lateral border of the ureter is spatulated with a laparoscopic scissor. angle of the anastomosis outside-in on the renal pelvis, and then inside-out on the ureter (Figure-7). The other sutures are placed in the posterior wall in the same fashion, in order to locate all the knots in the extraluminally. At this point, it is crucial to keep the nylon stitch pulled, maintaining the renal pelvis opened, and thus facilitating the sutures placement. The absence of a previously placed ureteral stent in the surgical field at this point makes posterior wall anastomosis easier to perform. Figure 7 - The first stitch is passed in the lateral angle of the anastomosis. The stitches are passed outside-in on the renal pelvis, and inside-out on the ureter, in order to place the knots outside the ureteral lumen. Percutaneous Stent Placement After completing the anastomosis of the posterior wall, a 7F ureteral stent (double-j) will be inserted in an antegrade fashion. An abdominal puncture is made with a 18G needle used for peripheral venous access. The needle is placed cephalad to the anastomotic site, towards the ureteral axis. A hydrophilic guidewire is inserted through the needle that, after entering the peritoneal cavity, is inserted in the ureter with a laparoscopic 442
5 removed on postoperative day 2. The retroperitoneal drain is removed shortly thereafter if there is no increase in output. The ureteral stent is generally removed in 6 weeks. Follow-up An intravenous pyelogram with furosemide is performed 2 months after stent removal if the patient is without any symptoms. A renal scan is performed annually thereafter, if the patient is still symptomfree. COMMENTS Figure 8 - Insertion of the guidewire in the ureter. The guidewire is inserted in the abdominal cavity from outside through a puncture with an 18G needle. Note that at this point the posterior wall of the anastomosis is completed. forceps (Figure-8). The presumed length of guidewire necessary to reach the bladder is inserted. The abdominal wall is dilated using dilators from a nephrostomy set until number 8F, permitting the passage of the double-j. The dilators can also be used to facilitate the introduction of the guidewire in the ureter, when the indroduction with the grasper is difficult. The double-j stent is then introduced through the guidewire in the abdominal cavity and penetrates the ureteral orifice with the aid of the positioner (Figure-9). Before introducing the entire stent, the bladder is filled with the saline solution mixed with methylene blue, previously connected to the Foley catheter. As the stent reaches the bladder, one may observe the exit of methylene blue through the anastomotic site, confirming the adequate placement of the stent and avoiding the need of radiologic control. After that, the guidewire is removed and only the proximal end of the stent will be outside the anastomosis (Figure-10). With a grasper, this part of the stent is introduced in the renal pelvis under direct vision (Figure-11). The anterior wall of the anastomosis is then completed with interrupted sutures (Figure-12), in a similar fashion of what was made for the posterior wall, and a suction drain is placed near the UPJ. If there is minimal output from the retroperitoneal drain, the bladder catheter is Laparoscopic pyeloplasty is a safe and effective procedure to treat UPJO. There is a clear advantage over other minimally invasive approaches and open procedures in respect to results and morbidity, respectively (4). We believe that the placement of the stent through an antegrade fashion may decrease radiation exposure and maintain the renal pelvis dilated, facilitating its dissection and, consequently, the anastomosis. Figure 9 After placing the guidewire, a 7F double-j stent is passed from outside the abdominal cavity using the guidewire to enter the ureter. The observation of methylene blue through the stent confirms its adequate position in the bladder. 443
6 Figure 12 - The anterior wall is closed with interrupted suture, completing the anastomosis. Figure 10 - The guidewire is removed and only the proximal portion of the stent is seen outside the ureter. REFERENCES 1. Nadler RB, Rao GS, Pearle MS, Nakada SY, Clayman RV: Acucise endopyelotomy: assessment of long-term durability. J Urol. 1996; 156: Scardino PT, Scardino PL: Obstruction of the Ureteropelvic Junction. In: Bergman H (ed.), The Ureter. New York, Springer-Verlag; 1981, p Schuessler WW, Grune MT, Tecyanhuey LV, Preminger GM: Laparoscopic dismembered pyeloplasty. J Urol. 1993; 150: Bauer JJ, Bishoff JT, Moore RG, Chen RN, Iverson AJ, Kavoussi LR: Laparoscopic versus open pyeloplasty: assessment of objective and subjective outcome. J Urol. 1999; 162: Jarret TW: Technique of laparoscopic pyeloplasty. Braz J Urol. 2000; 26: Received: April 24, 2002 Accepted after revision: August 21, 2002 Figure 11 - The proximal portion of the double-j is iserted in the renal pelvis with a grasper. Correspondence address: Dr. Henrique Rodrigues Rua Djalma Ulrich, 329 / 301 Rio de Janeiro, RJ, , Brazil Fax: hcrodrigues@uol.com.br 444
7 EDITORIAL COMMENT The authors are to be congratulated for developing a technique for placing and confirming ureteral stent placement during laparoscopic pyeloplasty. Over the last 12 years, laparoscopic urology has evolved from primarily a diagnostic modality to become a radical, extirpative procedure. The field continues to grow to encompass reconstructive procedures such as laparoscopic pyeloplasty, as well as vesical-urethral anastomosis during laparoscopic prostatectomy. Reconstructive laparoscopic procedures can be performed using either the Endostitch or free hand laparoscopic suturing using a needle driver. Robotic suturing may also prove to bridge the gap in laparoscopic training to allow urologists to perform complex laparoscopic procedures. As the surgeon places their hands at a remote console and moves handles located beneath a console, a robotic arm duplicates their hand movements with precision. Robotic instruments such as electrocautery, needle drivers, graspers, and scissors can then be used to perform complex laparoscopic procedures. The robotic articulated needle driver allows a larger range of motion compared to standard laparoscopic needle drivers which have fixed insertion sites at the trocar level, a limited range of motion, and limited angles. A three dimensional viewing screen also increases the depth of perception which may also aid the surgical perspective. The limitations of robotics include cost as well as lack of haptic, or force feedback. Currently, only visual clues are employed in order to determine the force being applied. This will be the next technological hurdle to overcome. The use of methylene blue in this manuscript avoids the need for fluoroscopy, as well as the need for cystoscopy and placement of a ureteral stent at the beginning of the procedure. The only caveat in performing the procedure this manner is that the distal ureter and ureteropelvic junction anatomy is not evaluated by retrograde pyelogram prior to the procedure, unless an intravenous pyelogram adequately delineates this anatomy. Benjamin R. Lee, M.D. Assistant Professor of Urology Director, Laparoscopy Section Long Island Jewish Medical Center New Hyde Park, New York, USA 445
TECHNIQUE OF ENDOPYELOTOMY WITH THE ACUCISE CUTTING BALLOON
Surgical Technique Brazilian Journal of Urology Official Journal of the Brazilian Society of Urology Vol. 26 (1): 71-75, January - February, 2000 TECHNIQUE OF ENDOPYELOTOMY WITH THE ACUCISE CUTTING BALLOON
More informationRobotic distal ureterectomy with psoas hitch and ureteroneocystostomy: Surgical technique and outcomes
Asian Journal of Urology (2015) 2, 123e127 HOSTED BY Available online at www.sciencedirect.com ScienceDirect journal homepage: www.elsevier.com/locate/ajur CASE REPORT Robotic distal with psoas hitch and
More informationProcedure related complications and how to prevent them
Procedure related complications and how to prevent them Rama Jayanthi, M.D. Section of Urology Nationwide Children s Hospital The Ohio State University Retroperitoneoscopic surgery Inadvertent peritoneal
More informationHydronephrosis after retroperitoneal laparoscopic. dismembered Anderson Hynes pyeloplasty in adult patients with ureteropelvic junction obstruction.
101 original paper TRAUMA AND RECONSTRUCTIVE UROLOGY Hydronephrosis after retroperitoneal laparoscopic dismembered Anderson Hynes pyeloplasty in adult patients with ureteropelvic junction obstruction:
More informationRetroperitoneoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Modification of the Procedure and Our Experience
LAPAROSCOPIC UROLOGY Retroperitoneoscopic Dismembered Pyeloplasty for Ureteropelvic Junction Obstruction: Modification of the Procedure and Our Experience Zhen-yu Ou, Jin-bo Chen, Zhi Chen, Min-feng Chen,
More informationSurgery Illustrated Surgical Atlas
Surgery Illustrated SURGERY ILLUSTRATEDMURPHY ET AL MURPHY ET AL. BJUI BJU INTERNATIONAL Surgery Illustrated Surgical Atlas Robotically assisted laparoscopic pyeloplasty Declan Murphy, Ben Challacombe,
More informationFIG The inferior and posterior peritoneal reflection is easily
PSOAS HITCH, BOARI FLAP, AND COMBINATION OF PSOAS 7 HITCH AND BOARI FLAP The psoas hitch procedure, Boari flap, and transureteroureterostomy are useful operative procedures for reestablishing continuity
More informationThe Minimally Invasive Management of Ureteropelvic Junction Obstruction in Horseshoe Kidneys
Thomas Jefferson University Jefferson Digital Commons Department of Urology Faculty Papers Department of Urology 1-25-2011 The Minimally Invasive Management of Ureteropelvic Junction Obstruction in Horseshoe
More informationORIGINAL ARTICLES Endourology
Urology Journal UNRC/IUA Vol. 1, No. 3, 165-169 Summer 2004 Printed in IRAN ORIGINAL ARTICLES Endourology A Comparison between Laparoscopic and Open Pyeloplasty in Patients with Ureteropelvic Junction
More informationResearch Article Laparoscopic Pyeloplasty for Ureteropelvic Junctions Obstruction in Adults: 6 Years Experience in One Center
Hindawi BioMed Research International Volume 2017, Article ID 6743512, 4 pages https://doi.org/10.1155/2017/6743512 Research Article Laparoscopic Pyeloplasty for Ureteropelvic Junctions Obstruction in
More informationINGUINAL HERNIA REPAIR PROCEDURE GUIDE
ROOM CONFIGURATION The following figure shows an overhead view of the recommended OR configuration for a da Vinci Inguinal Hernia Repair (Figure 1). NOTE: Configuration of the operating room suite is dependent
More informationRetroperitoneoscopic Transureteroureterostomy with Cutaneous Ureterostomy to Salvage Failed Ileal Conduit Urinary Diversion
available at www.sciencedirect.com journal homepage: www.europeanurology.com Case Study of the Month Retroperitoneoscopic Transureteroureterostomy with Cutaneous Ureterostomy to Salvage Failed Ileal Conduit
More informationKaiser Oakland Urology
Kaiser Oakland Urology What is Laparoscopy? Minimally invasive surgical alternative to standard surgery How is Laparoscopy Performed? A laparoscope and video camera are used to visualize internal organs
More informationLaparoscopic Radical Nephrectomy- the current gold standard
Laparoscopic Radical Nephrectomy- the current gold standard Anoop M. Meraney, M.D Director, Urologic Oncology, Helen and Harry Gray Cancer Center, Hartford Hospital and Connecticut Surgical Group. Is it
More informationLaparoscopic pyeloplasty with cephalad translocation of the crossing vessel a new approach to the Hellström technique
Original paper Videosurgery Laparoscopic pyeloplasty with cephalad translocation of the crossing vessel a new approach to the Hellström technique Tomasz Szydelko 1, Wojciech Apoznanski 2, Piotr Koleda
More informationManual on Preparation of Tissue for Neonatal Skills Course. Version 1.0_2018. Prepared by: Haitham Dagash. MBBS, FRCSEd (Paed)
Manual on Preparation of Tissue for Neonatal Skills Course Version 1.0_2018 Prepared by: Haitham Dagash MBBS, FRCSEd (Paed) University of Leicester and Leicester Infirmary Hospital Prof.Kokila Lakhoo PhD,FRCS(ENG+EDIN),FCS(SA),FCS(SA:PAED),MRCPCH,MBCHB
More informationRole of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study
466 O R I G I N A L P A P E R TRAUMA AND RECONSTRUCTIVE UROLOGY Role of laparoscopy in ureteropelvic junction obstruction with concomitant pathology: a case series study Omar Fahmy 1, Abdel-Rahman El-Fayoumi
More informationStudy of laparoscopic retroperitoneal pyeloplasty
International Surgery Journal Gajbhiye R et al. Int Surg J. 2015 Feb;2(1):53-59 http://www.ijsurgery.com pissn 2349-3305 eissn 2349-2902 Research Article DOI: 10.5455/2349-2902.isj20150210 Study of laparoscopic
More informationRobotic Surgery for Upper Tract Urothelial Carcinoma. Li-Ming Su, MD
Robotic Surgery for Upper Tract Urothelial Carcinoma Li-Ming Su, MD David A. Cofrin Professor of Urology, Associate Chairman of Clinical Affairs, Chief, Division of Robotic and Minimally Invasive Urologic
More informationAlthough open surgery has stood the test of time for
JOURNAL OF ENDOUROLOGY Volume 23, Number 3, March 2009 ª Mary Ann Liebert, Inc. Pp. 463 467 DOI: 10.1089=end.2008.0208 Laparoscopic Pyeloplasty: Our New Gold Standard Stephanie J. Symons, M.D., Parag S.
More informationRobotics, Laparoscopy & Endosurgery
Robotics, Laparoscopy and Endosurgery Robotics, Laparoscopy & Endosurgery How to preserve bladder neck during robotic radical prostatectomy? Abdullah Erdem Canda* Department of Urology, Yildirim Beyazit
More informationDoes antegrade JJ stenting affect the total operative time during laparoscopic pyeloplasty?
Turk J Urol 2017; 43(4): 497-501 DOI: 10.5152/tud.2017.77775 LAPAROSCOPY Original Article 497 Does antegrade JJ stenting affect the total operative time during laparoscopic pyeloplasty? Mustafa Suat Bolat,
More informationMinimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series
ORIGINAL Article Vol. 39 (2): 195-202, March - April, 2013 doi: 10.1590/S1677-5538.IBJU.2013.02.07 Minimally Invasive Pyeloplasty in Horseshoe Kidneys with Ureteropelvic Junction obstruction: A case series
More informationREPAIR OF LARGE CYSTOCELE
REPAIR OF LARGE CYSTOCELE WITH RAZ SUSPENSION 17 VAGINAL INCISION AND DISSECTION Premarin cream application to the anterior vagina daily for 1 month before cystocele repair enriches the vasculature and
More informationPeritoneal Dialysis Catheter Placement. Peritoneal Dialysis Catheter Placement. Peritoneal Dialysis Catheter Placement
ASDIN Advanced Techniques Pre-course Feb. 24, 2012 New Orleans, La Randall L. Rasmussen, MD Special thank you to Drs. Rajeev Narayan, San Antonio, Tx and Hemant Dhingra, Fresno Ca for lending me slides
More informationACUCISE TM ENDOPYELOTOMY IN A PORCINE MODEL: PROCEDURE STANDARDIZATION AND ANALYSIS OF SAFETY AND IMMEDIATE EFFICACY
Investigative Urology International Braz J Urol Official Journal of the Brazilian Society of Urology Vol. 30 (1): 59-65, January - February, 2004 ACUCISE TM ENDOPYELOTOMY IN A PORCINE MODEL: PROCEDURE
More informationOriginal Article Application of dual-knot continuous suture technique in retroperitoneal laparoscopic dismembered pyeloplasty
Int J Clin Exp Med 2016;9(5):8587-8592 www.ijcem.com /ISSN:1940-5901/IJCEM0017894 Original Article Application of dual-knot continuous suture technique in retroperitoneal laparoscopic dismembered pyeloplasty
More informationSara Schaenzer Grand Rounds January 24 th, 2018
Sara Schaenzer Grand Rounds January 24 th, 2018 Bladder Anatomy Ureter Anatomy Areas of Injury Bladder: Posterior bladder wall above trigone Ureter Crosses beneath uterine vessels At pelvic brim when ligating
More informationChapter 2. Simple Nephrectomy. Please Give Three Tips for Laparoscopic Simple Nephrectomy. Dr. de la Rosette
Chapter 2 Simple Nephrectomy Please Give Three Tips for Laparoscopic Simple Nephrectomy............. 39 How Does One Find the Renal Hilum during Transperitoneal Laparoscopic Nephrectomy?.................
More informationENDOPYELOTOMY WITH THE ACUCISE CATHETER
Clinical Urology International Braz J Urol Official Journal of the Brazilian Society of Urology Vol. 28 (4): 302-310, July - August, 2002 ENDOPYELOTOMY WITH THE ACUCISE CATHETER ARTUR H. BRITO, ANUAR I.
More informationCystotomy Laboratory Simulation
Kelli Braun MD, Robert Stager MD, Chadburn Ray MD, Bunja Rungruang MD Medical College of Georgia at Augusta University Note: This model can be used for Open Cystotomy Repair or Laparoscopic Cystotomy Repair.
More informationPelvioureteric junction obstruction of the lower collecting system associated with incomplete ureteral duplication: A case report
Ped Urol Case Rep 2014;1(6):11-15 DOI:10.14534/PUCR.201468061 PUCR Ped Urol Case Rep PEDIATRIC UROLOGY CASE REPORTS ISSN: 2148 2969 Journal homepage: http://www.pediatricurologycasereports.com Pelvioureteric
More informationRECTAL INJURY IN UROLOGIC SURGERY. Inadvertent rectal injury from a urologic procedure is often subtle but has serious postoperative consequences.
RECTAL INJURY IN 27 UROLOGIC SURGERY Inadvertent rectal injury from a urologic procedure is often subtle but has serious postoperative consequences. With good mechanical bowel preparation plus antibiotic
More informationFacing Surgery. for a Urinary Tract Condition? Learn about minimally invasive da Vinci Surgery
Facing Surgery for a Urinary Tract Condition? Learn about minimally invasive da Vinci Surgery The Condit ion: Urinary Tract Obstruction Your urinary system consists of two kidneys, two ureters and the
More informationUrologic Surgical Complications In Renal Transplantation
Urologic Surgical Complications In Renal Transplantation Chris Freise, MD Professor of Surgery UCSF Transplant Division Urologic Complications Review of Bladder Anastomosis Complications and Management
More informationLaparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty: a single surgical team experience with 38 cases
ORIGINAL ARTICLE Vol. 43 (3): 512-517, May - June, 2017 doi: 10.1590/S1677-5538.IBJU.2016.0198 Laparoscopic management of recurrent ureteropelvic junction obstruction following pyeloplasty: a single surgical
More informationFacing Surgery. for a Urinary Tract Condition? Learn about minimally invasive da Vinci Surgery
Facing Surgery for a Urinary Tract Condition? Learn about minimally invasive da Vinci Surgery The Condition: Urinary Tract Obstruction Your urinary system produces, stores, and eliminates urine. It includes
More informationRobotic Surgery for Prostate Cancer: A Realistic Approach to Getting Started The Evolution of a Robotic Surgeon
Robotic Surgery for Prostate Cancer: A Realistic Approach to Getting Started The Evolution of a Robotic Surgeon Douglas S. Scherr, M.D. Clinical Director, Urologic Oncology Weill Medical College of Cornell
More informationFeasibility and Preliminary Clinical Outcomes of Robotic Laparoendoscopic Single-Site (R-LESS) Pyeloplasty Using a New Single-Port Platform
EUROPEAN UROLOGY 62 (2012) 175 179 available at www.sciencedirect.com journal homepage: www.europeanurology.com Case Series of the Month Feasibility and Preliminary Clinical Outcomes of Robotic Laparoendoscopic
More informationSimplified Open Approach to Surgical Treatment of Ureteropelvic Junction Obstruction in Young Children and Infants
Hydronephrosis Simplified Open Approach to Surgical Treatment of Ureteropelvic Junction Obstruction in Young Children and Infants Eduardo Ruiz, Ricardo Soria, Edurne Ormaechea, Mauricio Marcelo Urquizo
More informationCopyright r 2015 Annals of Pediatric Surgery. Unauthorized reproduction of this article is prohibited.
Original article 231 Transperitoneal laparoscopic pyeloplasty in children and adolescents: long-term results Abdelbaset A.E. Elemam a, Rafik Shalaby b, Magid Ismail b, Mohamad Shahen b, Refaat Ibrahim
More informationColorectal procedure guide
Colorectal procedure guide Illustrations by Lisa Clark Biodesign ADVANCED TISSUE REPAIR cookmedical.com 2 INDEX Anal fistula repair Using the Biodesign plug with no button.... 4 Anal fistula repair Using
More informationRADICAL CYSTECTOMY. Solutions for minimally invasive urologic surgery
RADICAL CYSTECTOMY Solutions for minimally invasive urologic surgery The da Vinci Surgical System High-definition 3D vision EndoWrist instrumentation Intuitive motion RADICAL CYSTECTOMY Maintains the oncologic
More informationLaparoscopic Right Colectomy
Laparoscopic Right Colectomy Shawnee Mission Medical Center February 22, 2011 Hi, and welcome to the program. My name is Dr. Sanjay Thekkeurumbil, and I m a colorectal surgeon at Shawnee Mission Medical
More informationIdentifying unrecognized collecting system entry and the integrity of repair during open partial nephrectomy: comparison of two techniques
ORIGINAL ARTICLE Vol. 40 (5): 637-643, September - October, 2014 doi: 10.1590/S1677-5538.IBJU.2014.05.08 Identifying unrecognized collecting system entry and the integrity of repair during open partial
More informationROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY (RALP) Does The Patients Weight Effect The Surgical Results? Boris Chertin MD
ROBOTIC ASSISTED LAPAROSCOPIC PYELOPLASTY (RALP) Does The Patients Weight Effect The Surgical Results? Boris Chertin MD Chairman, The Departments of Urology & Pediatric Urology, Shaare Zedek Medical Center
More informationGENERAL GOALS & OBJECTIVES U-1. U-1 (PGY-2, 3) GENERAL GOALS and OBJECTIVES
GENERAL GOALS & OBJECTIVES U-1 U-1 (PGY-2, 3) GENERAL GOALS and OBJECTIVES In addition to the goals listed for PGY-1, the U-1 resident will add to his/her knowledge base by participating actively in conferences,
More informationExperimental Model of Upper-Pole Nephrectomy Using Human Tridimensional Endocasts: Analysis of Vascular Injuries
JOURNAL OF ENDOUROLOGY Volume 25, Number 1, January 2011 ª Mary Ann Liebert, Inc. Pp. 113 118 DOI: 10.1089=end.2010.0214 Experimental Model of Upper-Pole Nephrectomy Using Human Tridimensional Endocasts:
More informationTraining Course for Advanced Oncologic Laparoscopy. Robotic Urology. Ch.-H. Rochat Geneva
Training Course for Advanced Oncologic Laparoscopy Robotic Urology Ch.-H. Rochat Geneva St Petersbourg 16 February 2006 Urology and mini-invasive surgery radical prostatectomy nephrectomy (partial or total)
More informationRobot Assisted Rectopexy
1. Abdominal cavity approach 1A Trocars Introduce Introduce five trocars to gain access to the abdominal cavity (in da Vinci Si type; In Xi type the trocar placement may differ slightly). First the camera
More information90% of bladder tumours are transitional cell carcinoma (TCC), the remaining 10% of cases are squamous cell carcinoma, adenocarcinoma and sarcoma.
The Role of the Interventional Radiologist in Management of Post-Radical Cystectomy Ureteral Obstruction : A Case Review of Retrograde Transileal Conduit Ureteric Stents. Poster No.: C-2288 Congress: ECR
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,900 116,000 120M Open access books available International authors and editors Downloads Our
More informationSurgical Atlas The posterior lumbotomy
Original Article SURGERY ILLUSTRATED PANSADORO Surgical Atlas The posterior lumbotomy VITO PANSADORO Urology, Vincenzo Pansadoro Foundation, Rome, Italy ILLUSTRATIONS by STEPHAN SPITZER, www.spitzer-illustration.com
More informationDepartment of Urology, Columbia University School of Medicine, New York, NY
Laparoscopic Partial Nephrectomy Jaime Landman, MD Associate Professor of Urology Director of Minimally Invasive Urology Columbia University Department of Urology Department of Urology, Columbia University
More informationWhat CPT and ICD-10-CM codes are reported?
A patient is seen in the hospital s outpatient surgical area with a diagnosis of a displaced comminuted fracture of the lateral condyle, right elbow. An ORIF (open reduction) procedure was performed and
More informationNIH Public Access Author Manuscript Eur Urol. Author manuscript; available in PMC 2009 March 1.
NIH Public Access Author Manuscript Published in final edited form as: Eur Urol. 2008 March ; 53(3): 514 521. doi:10.1016/j.eururo.2007.09.047. ROBOTIC PARTIAL NEPHRECTOMY FOR COMPLEX RENAL TUMORS: SURGICAL
More informationEndoBlade Soft Tissue Release System
Surgical Technique Endoscopic Gastroc Recession Endoscopic Plantar Fascia Release EndoBlade Soft Tissue Release System Endoscopic Gastroc Recession Arthrex has developed a comprehensive, completely disposable
More informationda Vinci Prostatectomy My Greek personal experience
da Vinci Prostatectomy My Greek personal experience Vassilis Poulakis MD, PhD, FEBU Ass. Prof. of Urology Director of Urologic Clinic Doctors Hospital Athens Laparoscopy - golden standard in Urology -
More informationCook Europe Shared Service Centre
www.cookmedical.com Cook Europe Shared Service Centre Country Telephone E-mail Austria (+43) 1-795-67-121 oeorders@cook.ie Belgium ench (+32) 27-00-16-33 beorders@cook.ie Belgium Flemish (+32) 27-00-16-33
More informationENDOSCOPIC URETERECTOMY DURING NEPHROURETERECTOMY FOR UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA
ENDOSCOPIC URETERECTOMY DURING NEPHROURETERECTOMY FOR UPPER URINARY TRACT TRANSITIONAL CELL CARCINOMA Il. Saltirov, Ts. Petkov, G. Georgiev, K.Petkova Department of Urology and Nephrology, Military Medical
More informationThis information is intended as an overview only
This information is intended as an overview only Please refer to the INSTRUCTIONS FOR USE included with this device for indications, contraindications, warnings, precautions and other important information
More informationPercutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report
198) Prague Medical Report / Vol. 117 (2016) No. 4, p. 198 203 Percutaneous Nephrolithotomy in a Patient with Mainz Pouch II Urinary Diversion: A Case Report Stavros Sfoungaristos 1, Ioannis Mykoniatis
More informationNATIONAL INSTITUTE FOR CLINICAL EXCELLENCE
NATIONAL INSTITUTE FOR CLINICAL EXCELLENCE INTERVENTIONAL PROCEDURES PROGRAMME Interventional procedures overview of laparoscopic pyeloplasty Introduction This overview has been prepared to assist members
More informationFacing Surgery. for Urinary Tract Conditions? Learn why da Vinci Surgery may be your best treatment option
Facing Surgery for Urinary Tract Conditions? Learn why da Vinci Surgery may be your best treatment option The Condition: Urinary Tract Obstruction The urinary system is the group of organs that produces,
More informationTRANSURETHRAL RESECTION
TRANSURETHRAL RESECTION OF THE PROSTATE GLAND 21 Prostatic sonographic studies of patients who have undergone a transurethral resection of the prostate gland reveal large volumes of residual prostate tissue
More informationGoals & Objectives by Year in Training: U-1
Goals & Objectives by Year in Training: U-1 U-1 (PGY-2, 3) Resident Responsibilities, Goals and Objectives In addition to the goals listed for PGY-1, the U-1 resident will add to his/her knowledge base
More informationPyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients
Review Article Pyeloplasty techniques using minimally invasive surgery (MIS) in pediatric patients Francesco Turrà 1, Maria Escolino 1, Alessandra Farina 1, Alessandro Settimi 1, Ciro Esposito 1, François
More informationLaparoscopic Diverticulocystoplasty for Low Compliance Bladder in a Child
CASE REPORT Laparoscopic Diverticulocystoplasty for Low Compliance Bladder in a Child Manickam Ramalingam, MCh, Kallappan Senthil, MCh, Anandan Murugesan, MCh, Mizar Ganapathy Pai, MCh ABSTRACT Low compliance
More informationCover Page. The following handle holds various files of this Leiden University dissertation:
Cover Page The following handle holds various files of this Leiden University dissertation: http://hdl.handle.net/1887/6119 Author: Spruit, E.N. Title: Increasing the efficiency of laparoscopic surgical
More informationRetroperitoneal and Transperitoneal Robot-Assisted Pyeloplasty in Adults: Techniques and Results
EUROPEAN UROLOGY 58 (2010) 711 718 available at www.sciencedirect.com journal homepage: www.europeanurology.com Surgery in Motion Retroperitoneal and Transperitoneal Robot-Assisted Pyeloplasty in Adults:
More informationRetroperitoneal Laparoscopic Radical Nephroureterectomy for High Urothelial Tumours
Retroperitoneal Laparoscopic Radical Nephroureterectomy for High Urothelial Tumours A. Hașegan 1, V. Pîrvuț 1, I. Mihai 1, N. Grigore 1 1 Lucian Blaga University of Sibiu, Faculty of Medicine Clinical
More informationPercutaneous Nephrolithotomy and Laparoscopic Management of Urinary Tract Calculi
16 Percutaneous Nephrolithotomy and Laparoscopic Management of Urinary Tract Calculi Pedro-José López, Michael J. Kellett, and Patrick G. Duffy Urinary calculus in childhood is not common. The incidence
More informationPrevention of Surgical Injuries in Gynecology
in Gynecology John K. Chan, M.D. Division of Gynecologic Oncology Overview Review anatomy, etiology, intraoperative, postoperative management, prevention of injuries to: 1. Urinary tract 2. Gastrointestinal
More informationLaparoscopic Surgery. The Da Vinci Robot. Limits of Laparoscopy. What Robotics Offers. Robotic Urologic Surgery: A New Era in Patient Care
Laparoscopic Surgery Robotic Urologic Surgery: A New Era in Patient Care Laparoscopic technique was introduced in urologic surgery in the 1990s Benefits: Improved recovery time, decreased morbidity Matthew
More informationLAPAROSCOPIC PYELOPLASTY INFORMATION LEAFLET
LAPAROSCOPIC PYELOPLASTY INFORMATION LEAFLET Laparoscopic Pyeloplasty Page 1 of 8 LAPAROSCOPIC PYELOPLASTY This leaflet has been written to answers questions that you may have about your operation. If
More informationTesticular Vein Syndrome and Its Treatment with a Laparoscopic Approach
CASE REPORT Testicular Vein Syndrome and Its Treatment with a Laparoscopic Approach Nand Kishore Arvind, Onkar Singh, Shilpi Singh Gupta ABSTRACT Background and Objectives: Testicular vein syndrome (TVS)
More informationMorbidity Audit and Logbook Tool SNOMED Board Reporting Terms for SET and IMG Urology ENDOSCOPIC LOWER URINARY TRACT
ENDOSCOPIC LOWER URINARY TRACT Cystolitholapaxy Cystoscopic removal of foreign body from bladder Cystoscopic removal of ureteric stent Cystoscopy and cystodiathermy Cystoscopy and transurethral biopsy
More informationObjectives: To analyze various factors predicting success of retrograde ureteric stenting in managing patients with ureteric obstruction.
ISPUB.COM The Internet Journal of Urology Volume 14 Number 1 Factors Predicting Success Rate Of Retrograde Ureteric Stenting In Managing Patients With Ureteric Obstruction- Our Experiences In A South Indian
More informationPartial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches
Partial Nephrectomy Techniques for Renal Preservation: Historical and Modern Approaches Cary N Robertson MD FACS Associate Professor Division of Urology Associate Director Urologic Oncology Duke Cancer
More informationOutcomes of Infants Undergoing Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair
Outcomes of Infants Undergoing Robot-Assisted Laparoscopic Pyeloplasty Compared to Open Repair Pankaj P. Dangle, James Kearns, Blake Anderson and Mohan S. Gundeti* From the Department of Surgery, Division
More informationRobot-assisted laparoscopic rectal resection
Journal of Visceral Surgery (2014) 151, 377 387 Available online at ScienceDirect www.sciencedirect.com SURGICAL TECHNIQUE Robot-assisted laparoscopic rectal resection A. Valverde, N. Goasguen, O. Oberlin
More informationLaparoendoscopic Pfannenstiel Nephrectomy using Conventional Laparoscopic Instruments - Preliminary Experience
Surgical Technique Laparoendoscopic Pfannenstiel Nephrectomy International Braz J Urol Vol. 36 (6): 718-723, November - December, 2010 doi: 10.1590/S1677-55382010000600010 Laparoendoscopic Pfannenstiel
More informationCase Report The Role of Laparoscopic Nephrectomy in Pediatric Xanthogranulomatous Pyelonephritis: A Case Report
Case Reports in Urology Volume 2013, Article ID 598950, 4 pages http://dx.doi.org/10.1155/2013/598950 Case Report The Role of Laparoscopic Nephrectomy in Pediatric Xanthogranulomatous Pyelonephritis: A
More informationTechnique Guide. *smith&nephew N8TIVE ACL Anatomic ACL Reconstruction System
Technique Guide *smith&nephew N8TIVE ACL Anatomic ACL Reconstruction System N8TIVE ACL System The N8TIVE ACL Anatomic Reconstruction System provides a novel and simple approach to ACL repair. The N8TIVE
More informationBJUI. Robotic nephrectomy for the treatment of benign and malignant disease
. JOURNAL COMPILATION 2008 BJU INTERNATIONAL Laparoscopic and Robotic Urology ROGERS et al. BJUI BJU INTERNATIONAL Robotic nephrectomy for the treatment of benign and malignant disease Craig Rogers, Rajesh
More informationClinical Pearls: The Approach to the Management of Difficult Anatomy and Common Operative and Postoperative Problems
14 Clinical Pearls: The Approach to the Management of Difficult Anatomy and Common Operative and Postoperative Problems Vipul R. Patel The task of learning robotic prostatectomy can be quite challenging
More informationParenchyma-sparing lung resections are a potential therapeutic
Lung Segmentectomy for Patients with Peripheral T1 Lesions Bryan A. Whitson, MD, Rafael S. Andrade, MD, and Michael A. Maddaus, MD Parenchyma-sparing lung resections are a potential therapeutic option
More informationOutcomes of Re-Intervention for Laparoscopic Transperitoneal Pyeloplasty in Children. Leung, L; Chan, HYI; Chung, HY; Lan, CLL; Wong, KKY; Tam, PKH
Title Outcomes of Re-Intervention for Laparoscopic Transperitoneal Pyeloplasty in Children Author(s) Leung, L; Chan, HYI; Chung, HY; Lan, CLL; Wong, KKY; Tam, PKH Citation Journal of Laparoendoscopic &
More informationHydronephrosis. Nephrosis. Refers to the kidney
What is hydronephrosis? Hydro Nephrosis Refers to water or fluid Refers to the kidney A build-up of fluid (urine) in the kidney is the medical term for a build-up of urine in the kidney. As the urine builds
More informationLaparoscopic Ureterolithotomy: A Comparison Between the Transperitoneal and the Retroperitoneal Approach During the Learning Curve
JOURNAL OF ENDOUROLOGY Volume 23, Number 6, June 2009 ª Mary Ann Liebert, Inc. Pp. 953 957 DOI: 10.1089=end.2008.0055 Laparoscopic Ureterolithotomy: A Comparison Between the Transperitoneal and the Retroperitoneal
More informationIndex. Note: Page numbers of article title are in boldface type.
Index Note: Page numbers of article title are in boldface type. A Abscess(es) in Crohn s disease, 168 169 IPAA and, 110 114 as unexpected finding in colorectal surgery, 46 Adhesion(s) trocars-related laparoscopy
More informationTHE operation of reimplantation of the ureter into the bladder has undergone
REIMPLANTATION OF THE URETER INTO THE BLADDER J. G. WARDEN, M.D., and C. C. HIGGINS, M.D. Department of Urology THE operation of reimplantation of the ureter into the bladder has undergone a stormy course
More informationLaparoendoscopic Single-Site Nephrectomy Using Standard Laparoscopic Instruments
Laparoendoscopic Single-Site Nephrectomy Using Standard Laparoscopic Instruments Our Initial Experience LAPAROSCOPIC UROLOGY Alireza Aminsharifi, Bahman Goshtasbi, Firoozeh Afsar Department of Urology,
More informationObjectives. Pelvic Anatomy: Staying Out of Trouble. Disclosures. Anatomy 101. Anterior Abdominal Wall. Arcuate Line. Abheha Satkunaratnam MD, FRCS(C)
Objectives Pelvic Anatomy: Staying Out of Trouble Abheha Satkunaratnam MD, FRCS(C) To focus on key anatomy for the gynaecologic surgeon advancing their minimally invasive gynaecologic skills To provide
More informationPediatric Ure-Radiology*
Pediatric Ure-Radiology* HERMAN GROSSMAN, M.D. Professor of Radiology and Pediatrics, Duke University Medical Center, Durham, North Carolina "Routine" radiologic studies do not, often enough, concentrate
More informationParavaginal Repair: A Laparoscopic Approach
44 Paravaginal Repair: A Laparoscopic Approach John R. Miklos and Robert Moore Atlanta Urogynecology Associates, Atlanta, Georgia, U.S.A. Neeraj Kohli Harvard University, Boston, Massachusetts, U.S.A.
More informationPENETRATING COLON TRAUMA: THE CURRENT EVIDENCE
PENETRATING COLON TRAUMA: THE CURRENT EVIDENCE Samuel Hawkins MD CASE PRESENTATION 22M BIBEMS s/p multiple GSW ABCs intact Normotensive, non-tachycardic Secondary Survey: 4 truncal bullet holes L superior
More informationEndoscopic Component Separation November Philip Omotosho, MD Assistant Professor of Surgery Duke University School of Medicine
Endoscopic Component Separation November 2014 Philip Omotosho, MD Assistant Professor of Surgery Duke University School of Medicine Abdominal Wall Anatomy External Oblique Rectus Abdominus Internal Oblique
More informationSURGERY FOR PEYRONIE S DISEASE. PEYRONIE S DISEASE WITHOUT IMPOTENCE Exposure and Mobilization of Dorsal Nerves and Vessels
SURGERY FOR 25 PEYRONIE S DISEASE PEYRONIE S DISEASE WITHOUT Exposure and Mobilization of Dorsal Nerves and Vessels FIG. 25-1. Most surgeons use a degloving procedure via a circumferential skin incision
More informationFocused Assessment Sonography of Trauma (FAST) Scanning Protocol
Focused Assessment Sonography of Trauma (FAST) Scanning Protocol Romolo Gaspari CHAPTER 3 GOAL OF THE FAST EXAM Demonstrate free fluid in abdomen, pleural space, or pericardial space. EMERGENCY ULTRASOUND
More information